Department of Cardiology, Città della Salute e della Scienza, Turin, Italy.
Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University, Latina, Italy.
Panminerva Med. 2021 Sep;63(3):314-323. doi: 10.23736/S0031-0808.21.04263-4.
Recurrence is the most frequent complication following acute pericarditis and may occur in 30% patients, rising to 50% in case of multiple recurrences, lack of colchicine treatment or use of glucocorticoids. Available treatments include aspirin or non-steroidal anti-inflammatory drugs (NSAIDs), colchicine, glucocorticoids, immunosuppressive agents, immunoglobulins, anti-interleukin-1 (IL-1) agents.
This systematic review and meta-analysis of randomized controlled trials (RCTs) aimed to assess the efficacy of pharmacological treatments for acute and recurrent pericarditis. Bibliographic databases were searched (PubMed, MEDLINE, Embase, Scopus, and the Cochrane Library) using the terms "acute pericarditis" or "recurrent pericarditis" and "colchicine" or "NSAIDs" or "glucocorticoids" or "immunosuppressive agents" or "immunoglobulins" or "anti-IL1 agents." Random-effects meta-analysis was used to assess the risk of recurrent pericarditis. Publication bias was assessed using the Egger test, and meta-regression was performed to assess sources of heterogeneity.
Eleven RCTs assessed the efficacy of pharmacological treatments for acute and recurrent pericarditis (colchicine and anti-interleukin-1 agents). Colchicine, assessed in nine RCTs, was effective in the reduction of recurrent pericarditis, compared with standard treatment (17% vs .34%, RR=0.50; 95% CI 0.42-0.60, P<0.001), without any differences according to clinical setting (i.e. acute pericarditis, recurrent pericarditis, post-pericardiotomy syndrome; P=0.58). Anti-interleukin-1 agents (anakinra, rilonacept), assessed in two RCT, were effective in the reduction of recurrences, compared with placebo (10% vs.78%, RR=0.14; 95% CI 0.05-0.35, P<0.001).
A correct pharmacological management of pericarditis is key to prevent recurrences. Colchicine is the mainstay of treatment in acute and recurrent pericarditis, while anti-IL1 agents are a valuable option in case of recurrent pericarditis refractory to conventional drugs.
复发性心包炎是急性心包炎最常见的并发症，在 30%的患者中会发生，在多次复发、缺乏秋水仙碱治疗或使用糖皮质激素的情况下，发生率可上升至 50%。现有的治疗方法包括阿司匹林或非甾体抗炎药（NSAIDs）、秋水仙碱、糖皮质激素、免疫抑制剂、免疫球蛋白、抗白细胞介素-1（IL-1）药物。
本系统评价和随机对照试验（RCT）的荟萃分析旨在评估药物治疗急性和复发性心包炎的疗效。使用“急性心包炎”或“复发性心包炎”和“秋水仙碱”或“非甾体抗炎药”或“糖皮质激素”或“免疫抑制剂”或“免疫球蛋白”或“抗白细胞介素-1 药物”等术语，在 PubMed、MEDLINE、Embase、Scopus 和 Cochrane 图书馆等文献数据库中进行了检索。采用随机效应荟萃分析评估复发性心包炎的风险。采用 Egger 检验评估发表偏倚，并进行荟萃回归分析以评估异质性的来源。
11 项 RCT 评估了药物治疗急性和复发性心包炎（秋水仙碱和抗白细胞介素-1 药物）的疗效。在 9 项 RCT 中评估的秋水仙碱在降低复发性心包炎方面有效，与标准治疗相比（17%比 34%，RR=0.50；95%CI 0.42-0.60，P<0.001），且与临床环境无关（即急性心包炎、复发性心包炎、心包切开术后综合征；P=0.58）。在 2 项 RCT 中评估的抗白细胞介素-1 药物（阿那白滞素、利纳西普）在降低复发方面有效，与安慰剂相比（10%比 78%，RR=0.14；95%CI 0.05-0.35，P<0.001）。
正确的药物治疗是预防心包炎复发的关键。秋水仙碱是急性和复发性心包炎的主要治疗药物，而抗白细胞介素-1 药物是常规药物治疗无效的复发性心包炎的有效选择。
